The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Association of Body Mass Index and Weight Gain during Pregnancy with Postpartum Hemorrhage: A Case-Control Study

Document Type : Original Article

Authors
Fatemeh Shaabani 1
Vahideh Shirazi 2
Nazanin Shakibi 3
Rahmatollah Moradzadeh 4
Alireza Amani 5
Shima Alavi 6
Zohreh Radmehr 7
1 M.Sc. of Midwifery, Traditional and Complementary Medicine Research Center, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.
2 B.Sc. of Midwifery, Arak Quds Hospital, Arak, Iran.
3 M.Sc. of Consultant in Midwifery, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran.
4 Professor, Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran.
5 Assistant Professor, Department of Orthopedic Surgery, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
6 Obstetrician and Gynecologist, Qods Hospital, Arak, Iran.
7 Instructor, Department of Midwifery, Community Health Research Center, School of Nursing and Midwifery, Islamic Azad University, Isfahan Branch, Isfahan, Iran.
10.22038/ijogi.2026.89419.6479
Abstract
Introduction: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality worldwide, and obesity has been identified as a potential risk factor for PPH. However, the available evidence in indigenous populationsis limited and studies that have simultaneously examined the impact of BMI and gestational weight gain are few or sometimes inconsistent. Therefore, the present study was conducted with aim to investigate the association between BMI, gestational weight gain, and the risk of PPH.
Methods: This retrospective case-control study was conducted in 2018-2021 on 168 postpartum women (56 with PPH and 112 without PPH) in hospitals of Arak city. Data on body mass index, gestational weight gain, and demographic and obstetric characteristics were collected using patient records and interviews. Statistical analysis of data was performed using SPSS (version 21) and logistic regression, chi-square, and Mann-Whitney tests. P<0.05 was considered significant.
Results: There was no significant relationship between BMI and the incidence of postpartum hemorrhage (CI: (0.86-1.03), OR=0.95, p=0.219). Also, increasing BMI and weight gain during pregnancy reduced the chance of postpartum hemorrhage, but it was not statistically significant (p=0.184).
Conclusion: Based on the results, BMI and weight gain during pregnancy do not have a significant relationship with PPH. It is recommended that future studies examine the relationship between the causes of PPH separately and simultaneously with considering BMI.
Keywords
Body Mass Index
Gestational Weight Gain
Postpartum Hemorrhage
Subjects
1.        Newsome J, Martin JG, Bercu Z, Shah J, Shekhani H, Peters G. Postpartum hemorrhage. Tech Vasc Interv Radiol 2017; 20(4):266-273. doi:10.1053/j.tvir.2017.10.007.
2.        Tavakolipoor S, Nekuei NS, Beigi M. Evaluating the prevalence of different types of obstetric hemorrhage and its related factors. J Isfahan Med Sch 2018; 36(484):673-679. doi:10.22122/JIMS.V36I484.10069. [Persian].
3.        Biguzzi E, Franchi F, Ambrogi F, Ibrahim B, Bucciarelli P, Acaia B, et al. Risk factors for postpartum hemorrhage in a cohort of 6011 Italian women. Thromb Res 2012; 129(4):e1-e7. doi:10.1016/j.thromres.2011.09.010.
4.        Whitley J, Dazelle W, Kripalani S, Ahmadzia H. The association between body mass index and postpartum hemorrhage after cesarean delivery. Sci Rep 2023; 13:11998. doi:10.1038/s41598-023-38526-7.
5.        Li N, Liu E, Guo J, Pan L, Li B, Wang P, et al. Maternal prepregnancy BMI and gestational weight gain on pregnancy outcomes. PLoS One 2013; 8(12):e82310. doi:10.1371/journal.pone.0082310.
6.        Polic A, Curry TL, Louis JM. The impact of obesity on the management and outcomes of postpartum hemorrhage. Am J Perinatol 2022; 39(6):652-657. doi:10.1055/s-0040-1718574.
7.        Butwick AJ, Abreo A, Bateman BT, Lee HC, El-Sayed YY, Stephansson O, et al. Effect of maternal BMI on postpartum hemorrhage. Obstet Anesth Dig 2019; 39(1):18-19. doi:10.1097/ALN.0000000000002082.
8.        Humaira A, Munwar A, Saeed A, Nasim N, Saeed K, Yasmin S. Frequency of severe postpartum hemorrhage after delivery among obese pregnant women. Pak J Med Health Sci 2022; 16(2):324. doi:10.53350/pjmhs22162324.
9.        Kınay T, Özelçi R, Dilbaz B, Kahyaoğlu İ, Tekin ÖM. Relationship between gestational weight gain and amount of postpartum bleeding. J Contemp Med 2020; 10(3):365-369. doi:10.16899/jcm.636511.
10.     Ashoori N, Kordi M, Shakeri MT, Tara F. Vaginal postpartum hemorrhage: incidence, risk factors, and causes. Iran J Obstet Gynecol Infertil 2019; 21(12):65-76. doi:10.22038/ijogi.2019.12667.
11.     Dorosti AR. Guide to weight gain in pregnant women: for the family physician health team. Tehran: Andishe Mandegar Publications; 2012. [Persian].
12.     Ministry of Health and Medical Education (IR). Obstetric hemorrhage management protocol: for obstetricians, anesthesiologists, and midwifery staff. 1nd ed. Tehran: Department of Maternal Health, Office of Population, Family and School Health; 2019. [Persian].
13.     Ministry of Health and Medical Education (IR). Clinical practice guideline for postpartum hemorrhage. Tehran: Office of Technology Assessment, Standardization and Health Tariff; 2019. [Persian].
14.     Secretariat of the Strategic Council for Health Guidelines (IR). Clinical pathway: management of obstetric hemorrhage. Tehran: Secretariat of the Strategic Council for Health Guidelines; 2021. [Persian].
15.     Halle-Ekane G, Emade F, Bechem N, Palle J, Fongaing D, Essome H, Fomulu N. Prevalence and risk factors of primary postpartum hemorrhage after vaginal deliveries in the Bonassama District Hospital, Cameroon. Int J Trop Dis Health 2016; 13(2):1-2.
16.     Chawanpaiboon S, Lucksanapanij M. Impact of Maternal Weight and Gestational Weight Gain on Postpartum Hemorrhage and Adverse Outcomes: A Case–Control Study. International Journal of Women's Health 2025: 3567-75.
17.     Ononge S, Mirembe F, Wandabwa J, Campbell OM. Incidence and risk factors for postpartum hemorrhage in Uganda. Reprod Health 2016; 13:1-7. doi:10.1186/s12978-016-0154-8.
18.     Ovesen P, Rasmussen S, Kesmodel U. Effect of prepregnancy maternal overweight and obesity on pregnancy outcome. Obstet Gynecol 2011; 118(2 Pt 1):305-312. doi:10.1097/AOG.0b013e3182245d49.
19.     D’Souza R, Horyn I, Pavalagantharajah S, Zaffar N, Jacob CE. Maternal body mass index and pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2019; 1(4):100041. doi:10.1016/j.ajogmf.2019.100041.
20.     Athukorala C, Rumbold AR, Willson KJ, Crowther CA. The risk of adverse pregnancy outcomes in women who are overweight or obese. BMC Pregnancy Childbirth 2010; 10:56. doi:10.1186/1471-2393-10-56.
21.     Bateman BT, Berman MF, Riley LE, Leffert LR. The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries. Anesth Analg 2010; 110(5):1368-1373. doi:10.1213/ANE.0b013e3181d74898.
22.     Ashwal E, Bergel Bson R, Aviram A, Hadar E, Yogev Y, Hiersch L. Risk factors for postpartum hemorrhage following cesarean delivery. J Matern Fetal Neonatal Med 2022; 35(18):3626-3630. doi:10.1080/14767058.2020.1834533.
23.     Ekin A, Gezer C, Solmaz U, Taner CE, Dogan A, Ozeren M. Predictors of severity in primary postpartum hemorrhage. Arch Gynecol Obstet. 2015; 292:1247-1254. doi:10.1007/s00404-015-3771-5.
24.     Shahbazi Sighaldeh S, Nazari A, Maasoumi R, Kazemnejad A, Mazari Z. Prevalence, related factors and maternal outcomes of primary postpartum haemorrhage in governmental hospitals in Kabul-Afghanistan. BMC Pregnancy Childbirth 2020; 20:313. doi:10.1186/s12884-020-03123-3.
25.     Choe SA, Min HS, Cho SI. The income-based disparities in preeclampsia and postpartum hemorrhage: a study of the Korean National Health Insurance cohort data from 2002 to 2013. Springerplus 2016; 5:1860. doi:10.1186/s40064-016-2620-8.
26.     Palmsten K, Hernández-Díaz S, Huybrechts KF, Williams PL, Michels KB, Achtyes ED, et al. Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. BMJ 2013; 347:f4877. doi:10.1136/bmj.f4877.
27.     van Stralen G, von Schmidt auf Altenstadt JF, Bloemenkamp KW, van Roosmalen J, Hukkelhoven CWPM. Increasing incidence of postpartum hemorrhage: the Dutch piece of the puzzle. Acta Obstet Gynecol Scand 2016; 95(10):1104-1110. doi:10.1111/aogs.12950.
28.     Maswime S, Buchmann E. A systematic review of maternal near miss and mortality due to postpartum hemorrhage. Int J Gynaecol Obstet 2017; 137(1):1-7. doi:10.1002/ijgo.12096.
29.     Kebede BA, Abdo RA, Anshebo AA, Gebremariam BM. Prevalence and predictors of primary postpartum hemorrhage: An implication for designing effective intervention at selected hospitals, Southern Ethiopia. PloS one 2019; 14(10):e0224579.
30.     Driessen M, Bouvier-Colle MH, Dupont C, Khoshnood B, Rudigoz RC, Deneux-Tharaux C. Postpartum hemorrhage resulting from uterine atony after vaginal delivery: factors associated with severity. Obstet Gynecol 2011; 117(1):21-31. doi:10.1097/AOG.0b013e318202c845.
31.     Liu CN, Yu FB, Xu YZ, Li JS, Guan ZH, Sun MN, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study. BMC pregnancy and childbirth 2021; 21(1):332.
32.     Hiersch L, Bergel-Bson R, Asher D, Aviram A, Gabby-Benziv R, Yogev Y, et al. Risk factors for postpartum hemorrhage following vacuum-assisted vaginal delivery. Arch Gynecol Obstet 2017; 295:75-80.
33.     Nyfløt LT, Sandven I, Stray-Pedersen B, Pettersen S, Al-Zirqi I, Rosenberg M, et al. Risk factors for severe postpartum hemorrhage: a case-control study. BMC Pregnancy Childbirth 2017; 17:17. doi:10.1186/s12884-016-1217-0.
34.     Rocha Filho EA, Costa ML, Cecatti JG, Parpinelli MA, Haddad SM, Pacagnella RC, et al. Severe maternal morbidity and near miss due to postpartum hemorrhage in a national multicenter surveillance study. Int J Gynaecol Obstet 2015; 128(2):131-136. doi:10.1016/j.ijgo.2014.08.023.
35.     Zemorshidi M, Ghomian N, Khadem-Rezaiyan M. The ratio of severe maternal outcome and its related factors in an academic hospital from October 2019 to October 2020. The Iranian Journal of Obstetrics, Gynecology and Infertility 2022; 25(3):60-8.
36.     Sheldon W, Blum J, Vogel J, Souza J, Gülmezoglu A, Winikoff B, et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 Suppl 1:5-13. doi:10.1111/1471-0528.12636.
37.     Monfared AB, Hatami H, Isabeiglou H. Prevalence and associated factors of overweight and obesity in reproductive-aged women in Rasht. J Health Field 2016; 4:39-46.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 29, Issue 3
May 2026
Pages 62-74